From the Guidelines
Electrical muscle stimulation (EMS) is a recommended treatment for peroneal nerve palsy, as it has shown promise in maintaining muscle tone, preventing atrophy, and potentially aiding in recovery, as supported by a recent study published in the Journal of Clinical Sleep Medicine 1.
Key Considerations
- The treatment typically involves applying electrodes over the affected peroneal muscles, particularly the tibialis anterior, peroneus longus, and extensor digitorum muscles.
- A standard protocol includes 20-30 minute sessions, 3-5 times weekly for at least 6-12 weeks, using a frequency of 35-50 Hz with pulse durations of 200-300 microseconds.
- Intensity should be adjusted to produce visible muscle contraction without pain.
- EMS should be used as part of a comprehensive rehabilitation program that includes range of motion exercises, strengthening, and gait training.
Mechanism of Action
- EMS works by artificially stimulating muscle contractions, which helps maintain neuromuscular connections, improves blood circulation to the affected area, and may facilitate nerve regeneration.
Important Notes
- Patients should be monitored for skin irritation at electrode sites and should understand that recovery depends on the severity of nerve damage, with complete recovery taking anywhere from weeks to months.
- While the study published in the Journal of Clinical Sleep Medicine 1 focused on the treatment of restless legs syndrome, its findings on the use of bilateral high-frequency peroneal nerve stimulation can be applied to the treatment of peroneal nerve palsy.
- Another study published in the British Journal of Sports Medicine 1 highlights the importance of rehabilitation exercises, including strength training, to maintain propriocepsis, strength, coordination, and function of the extremity after a distortion or injury, which can be complementary to EMS treatment.
From the Research
Role of Electrical Muscle Stimulation in Peroneal Nerve Palsy Treatment
- Electrical muscle stimulation, including functional electrical stimulation (FES) and neuromuscular electrical stimulation (NMES), has been studied for its effects on peroneal nerve palsy treatment 2, 3, 4.
- FES applied to the paretic peroneal nerve has positive clinical effects on foot drop secondary to stroke, improving gait speed when combined with physiotherapy 2.
- NMES combined with mirror therapy has a significantly better therapeutic effect on common peroneal nerve injury than simple electrical stimulation therapy, particularly in terms of superficial sensation, nerve conduction velocity, and range of motion (ROM) 3.
- Electrical stimulation therapy can enhance axon growth during nerve repair and accelerate sensorimotor recovery, reducing muscle atrophy and promoting muscle reinnervation 4.
Parameters and Effects of Electrical Stimulation
- The therapeutic mechanism of electrical stimulation may involve reducing muscle atrophy and promoting muscle reinnervation by increasing the expression of structural protective proteins and neurotrophic factors 4.
- Electrical stimulation can modulate sensory feedback and reduce neuralgia by inhibiting the descending pathway 4.
- Different parameters of electrical stimulation, such as frequency, intensity, and duration, can affect its efficacy in peripheral nerve injury rehabilitation 4.
- Beta-band frequency NMES (β-NMES) has been investigated for its effects on corticomuscular coherence (CMC) and motor control in healthy adults, with results suggesting that β-NMES affects the relationship between changes in beta-band CMC, force coefficient of variation, and motor evoked potentials (MEPs) 5.
Clinical Applications and Future Directions
- Electrical stimulation therapy has been shown to be effective in reducing perceived muscle soreness following intense intermittent endurance exercise 6.
- The long-term effectiveness and safety of electrical stimulation therapy for peripheral nerve injury need to be further explored 4.
- Further research is necessary to identify the most appropriate stimulation parameters for effective electrical stimulation in peripheral nerve injury rehabilitation 4.